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Title: Cardiovascular disease and its impact on longevity and longevity improvement
Author: Gitsels, Lisanne
ISNI:       0000 0004 6351 1764
Awarding Body: University of East Anglia
Current Institution: University of East Anglia
Date of Award: 2017
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An increased risk or a history of cardiovascular disease (CVD) is associated with worse survival prospects. Clinical guidelines recommend several treatments for primary and secondary prevention. These guidelines are mainly based on clinical trials and hospital data. Data from routine clinical practice could provide insights in longevity and longevity improvement in the general population as opposed to selected patients. The primary objectives of this research were to investigate how a history of CVD affects longevity in residents of the United Kingdom at retirement age, and to investigate which treatments improve longevity. Medical records from 1987 to 2011 from general practices contributing to The Health Improvement Network (THIN) database were used to develop two specific survival models: to estimate the hazards of all-cause mortality associated with a history of acute myocardial infarction (AMI) and related treatments, and to estimate the hazard of all-cause mortality associated with statins prescribed as primary prevention of CVD. The models were multilevel Cox's proportional hazards regressions that included comorbidities, treatments, lifestyle choices, and socio-demographic factors. The models were specified for ages 60, 65, 70, and 75. More accurate estimates of longevity at these key ages could inform future medical management by clinicians and financial planning for retirement by individuals, actuaries, and the government. This research found that survival prospects after AMI were reduced by less than previous studies have reported. Furthermore, currently recommended treatments for CVD were associated with mixed survival prospects, in which coronary revascularisation and prescription of beta blockers and statins were associated with improved prospects and prescription of ACE inhibitors and aspirin were associated with worsened prospects.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available